Information Collection

Data and Technical Assistance (DATA) Task Order to Support the Infant Mortality CoIIN

IC 230710 under ICR 201502-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Data and Technical Assistance (DATA) Task Order to Support the Infant Mortality CoIIN	Form
1 DATA CoIIN_ Post-TA Webinar Evaluation Survey.pdf DATA CoIIN_TA Webinar Evaluation Survey.pdf	Form
2 DATA CoIIN_Post-Stakeholder Webinar Evaluation Survey.pd DATA CoIIN_Stakeholder Webinar Evaluation Survey.pdf	Form
3 DATA CoIIN_Web-based Shared workspace/Online Platform Su DATA CoIIN_Online Platform Survey.pdf	Form
GENERIC - Supporting Statement_DATA CoIIN_030918.docx Generic DATA COIIN Supporting Statement	IC Document

IC Title:

Data and Technical Assistance (DATA) Task Order to Support the Infant Mortality CoIIN

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	DATA CoIIN_ Post-TA Webinar Evaluation Survey.pdf	DATA CoIIN_TA Webinar Evaluation Survey.pdf	Yes	Yes	Fillable Fileable
Form	2	DATA CoIIN_Post-Stakeholder Webinar Evaluation Survey.pdf	DATA CoIIN_Stakeholder Webinar Evaluation Survey.pdf	Yes	Yes	Fillable Fileable
Form	3	DATA CoIIN_Web-based Shared workspace/Online Platform Survey.pdf	DATA CoIIN_Online Platform Survey.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 540

Number of Respondents for Small Entity: 53

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,670	2,670
Annual IC Time Burden (Hours)	214	214
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic DATA COIIN Supporting Statement	GENERIC - Supporting Statement_DATA CoIIN_030918.docx	03/14/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.